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BMC Health Services Research
Published in: BMC Health Services Research 1/2015

Open Access 01-12-2015 | Study protocol

Protocol for the evaluation of a free health insurance card scheme for poor pregnant women in Mbeya region in Tanzania: a controlled-before and after study

Authors: Josephine Borghi, Kate Ramsey, August Kuwawenaruwa, Jitihada Baraka, Edith Patouillard, Ben Bellows, Peter Binyaruka, Fatuma Manzi

Published in: BMC Health Services Research | Issue 1/2015

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Abstract

Background

The use of demand-side financing mechanisms to increase health service utilisation among target groups and enhance service quality is gaining momentum in many low- and middle-income countries. However, there is limited evidence on the effects of such schemes on equity, financial protection, quality of care, and cost-effectiveness. A scheme providing free health insurance cards to poor pregnant women and their households was first introduced in two regions of Tanzania in 2011 and gradually expanded in 2012.

Methods

A controlled before and after study will examine in one district the effect of the scheme on utilization, quality, and cost of healthcare services accessed by poor pregnant women and their households in Tanzania. Data will be collected 4 months before implementation of the scheme and 17 months after the start of implementation from a survey of 24 health facilities, 288 patients exiting consultations and 1500 households of women who delivered in the previous year in one intervention district (Mbarali). 288 observations of provider-client interactions will also be carried out. The same data will be collected from a comparison district in a nearby region. A process evaluation will ascertain how the scheme is implemented in practice and the level of implementation fidelity and potential moderators. The process evaluation will draw from impact evaluation data and from three rounds of data collection at the national, regional, district, facility and community levels. An economic evaluation will measure the cost-effectiveness of the scheme relative to current practice from a societal perspective.

Discussion

This evaluation will generate evidence on the impact and cost-effectiveness of targeted health insurance for pregnant women in a low income setting, as well as building a better understanding of the implementation process and challenges for programs of this nature.
Footnotes
1
Selected facilities must have been in operation for at least 3 years, and have adequate infrastructure, equipment and staff, as ascertained by the NHIF.
 
2
Individual targeting is based on 8 components relating to: housing characteristics (housing materials, water and cooking fuel sources, and sanitation facilities); household remoteness from health providers; income; food security and the number of dependents including those with disabilities. Each component is scored between 1 and 3 depending on the degree to which the household is deemed to be poor (from 1 poorest, to 3 least poor), and then aggregated without weighting to obtain a total poverty score.
 
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Metadata
Title
Protocol for the evaluation of a free health insurance card scheme for poor pregnant women in Mbeya region in Tanzania: a controlled-before and after study
Authors
Josephine Borghi
Kate Ramsey
August Kuwawenaruwa
Jitihada Baraka
Edith Patouillard
Ben Bellows
Peter Binyaruka
Fatuma Manzi
Publication date
01-12-2015
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2015
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/s12913-015-0905-1

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